P1529: HEMOGLOBIN RESPONSE TO ZINC SUPPLEMENTATION IN PATIENTS WITH ZINC DEFICIENCY AND CHRONIC ANEMIA
Authors: Z. Hanson, S. Kaur, S. Lee, M. Akhtari
Journal: HemaSphere (2022)

Background: Zinc is a necessary micronutrient used as a catalyst, structural element, and regulatory ion in many metabolic processes including erythropoiesis. While zinc fortification has been studied in developing countries and has been associated with a decrease in the overall prevalence of anemia within the pediatric and maternal populations (Ara et al., PLoS One. 2019;14(1); Saaka, Ghana Med J. 2012;46(4):225-233), there have been no studies in adults with chronic anemic in the developed world. This descriptive, retrospective, study describes zinc deficient patients with chronic anemia, who underwent zinc supplementation, and their changes in hemoglobin (HGB) over a 6-month period, in an academic outpatient hematology center in California, United States of America. Aims: Primary endpoints: determine if zinc supplementation in zinc deficient patients with chronic anemia will improve HGB by at least 0.5 g/dL by 1, 3, and 6 month time points. Secondary endpoints: subgroup analysis for HGB improvement by 1, 3, and 6 month time points between all patients versus those with rheumatologic disorders, active malignancy, and patients with chronic kidney disease (CKD) including end stage renal disease (ESRD). Methods: Twenty-Nine patients with chronic anemia (HGB <12 for women, HGB <13 for men for >3 months) over the age of 18 were identified to have zinc deficiency (plasma zinc concentration <65 ug/dL). Patients did not have elevated inflammatory markers (C-reactive protein (CRP) >5 mg/L, and erythrocyte sedimentation rate (ESR) >22 mm/hr for males, >29 mm/hr for females) at time of plasma zinc collection nor started new treatment for malignancy or rheumatologic disorder 3 months preceding, and within the data collection period. A retrospective data collection was completed for prior medical history, HGB, hematocrit (HCT), platelets (PLTS), mean corpuscular volume (MCV), plasma zinc concentration, CRP, ESR, and glomerular filtration rate (GFR). HGB was collected at the time markers of 1, 3, and 6 months following initiation of zinc supplementation. Collected data was analyzed with ANOVA and CHI-squared for response in all patients. Subgroup analysis was then completed if patients had been diagnosed with rheumatologic disorders (systemic lupus erythematosus and Sjogren disorder), active malignancy, or CKD including ESRD. Results: Prior to supplementation, average hemoglobin among patients was 9.95 g/dL, WBC was 5.0 g/dL, MCV was 92.3 fl, PLTS were 220 g/dL. Following 1 month of supplementation average hemoglobin was 10.9 g/dL (p = 0.029, n = 23), at 3 months average hemoglobin was 11.0 g/dL (p = 0.016, n = 24), and at 6 months average hemoglobin was 11.5 g/dL (p = 0.001, n = 20). Primary endpoint of HGB improvement by at least 0.5 g/dL was found in 61% of patients at 1 month, 66% of patients at 3 months, and 80% of patients at 6 months. Hemoglobin improved by at least 1.0 g/dL in 48% of patients at 1 month, 42% of patients at 3 months, and 65% of patients at 6 months. Resolution of anemia was reached in 36% of patients within 6 months. The secondary endpoint with subgroup analysis for patients with rheumatologic disorders, active malignancy, or CKD including ESRD versus the group as a whole showed no significant differences in response. Image:Summary/Conclusion: Zinc supplementation significantly improved hemoglobin levels in patients with zinc deficiency and chronic anemia, independent of their underlying comorbidities, with resolution of anemia in 36% of patients. A large prospective study is needed to evaluate and correlate zinc supplementation and hemoglobin improvement in patients with chronic anemia.